肺诺卡菌病12例临床分析  

Retrospective analysis of 12 cases of pulmonary nocardiosis

作　　者：张盛斌[1] 朱红军[3] 林茂煌[1] 张淇钏[1] 刘朝晖[2] ZHANG Shengbin;ZHU Hongjun;LIN Maohuang;ZHANG Qichuan;LIU Zhaohui(Department of Respiratory Medicine,Shantou Central Hospital,Shantou Guangdong 515031,China)

机构地区：[1]汕头市中心医院呼吸内科,广东汕头515031 [2]广州市第一人民医院 [3]汕头市中心医院细菌室,广东汕头515031

出　　处：《中国感染与化疗杂志》2020年第4期401-405,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨肺诺卡菌病的特点,为临床诊治提供帮助。方法收集汕头市中心医院2017年1月-2019年7月确诊为肺诺卡菌病患者的临床资料进行回顾性分析。结果 12例肺诺卡菌病患者中,男5例,女7例,年龄26~89岁,平均(65.0±17.8)岁;均伴有多种基础疾病,其中,支气管扩张6例,肺结核3例,慢性阻塞性肺疾病2例,血液系统恶性肿瘤2例,糖尿病1例,自身免疫性疾病1例。临床表现主要有咳嗽、咯痰、发热、气促、咯血等。胸部影像学可同时出现多种表现,其中阴影呈斑片状8例,团块状6例,结节状4例,肺实变1例,空洞形成1例。实验室检查均有白细胞和中性粒细胞升高。确诊通过痰培养11例,支气管肺泡灌洗液培养1例,确诊时间为5~21 d,平均(10.6±4.4)d。药敏试验结果显示对甲氧苄啶-磺胺甲■唑、利奈唑胺、米诺环素、亚胺培南和头孢曲松具有较高的敏感率。应用甲氧苄啶-磺胺甲■唑联合β内酰胺类或喹诺酮类治疗的5例患者,病情均好转;7例应用β内酰胺类或喹诺酮类,其中5例好转,2例病情恶化。结论肺诺卡菌病易发生在患有结构性肺病和免疫功能低下的人群,临床症状、胸部影像学和实验室检查均缺乏特异性,标本培养诺卡菌阳性是诊断该病的关键,但报告时间较长。治疗应以甲氧苄啶-磺胺甲■唑为主的联合治疗,改善预后。Objective To explore the characteristics of pulmonary nocardiosis for better clinical diagnosis and treatment.Methods A retrospective study was conducted to analyze the data of patients with pulmonary nocardiosis admitted to Shantou Central Hospital from January 2017 to July 2019.Results The 12 patients (5 males and 7 females) aged (65.0±17.8) years old on average (range:26-89 years).All the patients had multiple complications:bronchiectasis (6 cases),pulmonary tuberculosis (3 cases),chronic obstructive pulmonary disease and hematological malignances (2 each),diabetes mellitus and autoimmune disease (1 each).The most common symptoms were cough,expectoration,fever,breathlessness,and hemoptysis.The main findings on lung CT scans included patchy opacities (8 cases),masses (6 cases),nodules (4 cases),consolidation (1 case) and cavity formation (1 case).Both leukocytes and neutrophils increased.The diagnosis was confirmed by sputum culture in 11 cases,by bronchoalveolar lavage culture in one case.The time to diagnosis was (10.6±4.4) days on average (range:5-21 days).The antimicrobial susceptibility testing showed that Nocardia pathogens were relatively more susceptible to trimethoprim-sulfamethoxazole,linezolid,minocycline,imipenem and ceftriaxone.All the five patients treated with trimethoprim-sulfamethoxazole plus β-lactams or quinolones got improved.Of the 7 patients treated with β-lactams or quinolones,5 were improved and 2 got worse.Conclusions Structural lung disease and immunocompromised status make individuals vulnerable to pulmonary nocardiosis.The clinical manifestation,chest imaging and laboratory tests are not specific.The positive culture result of Nocardia is the key to diagnosis,but the time to diagnosis by culture is still too long.Trimethoprim-sulfamethoxazole-based combination therapy should be considered for good outcome.

关 键 词：肺诺卡菌病 临床特点 诊断 治疗 

分 类 号：R519.1[医药卫生—内科学]